Page 17 - Work Force March 2019

Expanded Plan Information for Empire
Coming in March: IRS Form 1095-C
for NYSHIP State Enrollees
To comply with federal health care reform provisions, New York State is required to send IRS tax form 1095-C to all full-time employees, enrollees in The Empire Plan or NYSHIP HMOs, as well as retirees who are not enrolled in Medicare.
Form 1095-C presents data to be provided to the IRS by the state as proof of qualifying health insurance coverage for 2018.
Federal law requires that Form 1095-C be sent to all employees who meet the U.S. Patient Protection and Affordable Care Act’s definition of a full-time employee. This is generally defined as individuals who work at least 30 hours per week or 130 hours per month.
In addition to full-time employees, the state will also send Form 1095-C to any other individuals who were enrolled in The Empire Plan or the Student Employee Health Plan (SEHP) for all or a portion of 2018. If you were enrolled in a Health Maintenance Organization (HMO) for all or a portion of 2018, you may receive a similar form, Form 1095-B, from your HMO as well.
Individuals who are enrolled in Medicare or who provide coverage to any dependents enrolled in Medicare should note that enrollment information for Medicare enrollees will not appear on Form 1095- C. You may receive a separate Form 1095-B from Medicare for these individuals.
The 1095-C forms will be mailed in early March; please review it for accuracy and retain it with your tax records. You do not need to return the form to New York State, and it does not need to be filed with your federal or state income tax return.
If any of the information contained on your Form 1095-C is inaccurate, call the telephone number on the upper right corner of the form to correct any errors.
TPlan Enrollees
he Empire Plan Reporting On is a publication
issued periodically by the New York State Department of Civil Service to Empire Plan enrollees and their enrolled Empire Plan dependents, COBRA enrollees with Empire Plan benefits and Young Adult Option enrollees.
Various series of the publication feature information crucial to understanding your Empire Plan benefits on topics such as:
• Centers of Excellence (August 2018)
describes how the Empire Plan’s Centers of Excellence Programs for Cancer, Transplants and Infertility can help Empire Plan enrollees facing medical crises.
• Prescription Drugs (November 2018)
discusses specific information on copayment levels, mandatory generic substitution, the Flexible Formulary Drug List, Specialty Pharmacy Program and Drug Utilization Review under the Plan.
• Network Benefits (November 2018)
discusses the benefits available to Empire Plan enrollees who use participating and network providers for Medical/Surgical, Hospital, Mental Health and Substance services.
• Home Care Advocacy Program (November 2018) explains how Home
Care Advocacy Program (HCAP) under the Empire Plan provides in-home services and supplies when prescribed by your doctor.
symptoms, treatment and complications associated with type 1 and type 2 diabetes, as well as benefits available through HCAP and Empire Plan’s Diabetes Management Program.
• Asthma (June 2018) discusses the causes and symptoms of asthma, how to avoid triggers, the Plan’s Asthma Management Program and HCAP.
• Prenatal Care (September 2018) explains the components of good prenatal care, including pregnancy planning, nutrition, postpartum depression and the Empire Plan’s Future Moms Program.
• Smoking Cessation (August 2018)
discusses the addictive power of nicotine, conditions and diseases caused by smoking, quit strategies and information on the smoking cessation treatments covered by the Empire Plan.
These publications are available on NYSHIP Online: www.cs.ny.gov/employee-benefits
Choose your group (Active State, then CSEA and Empire Plan. Choose “Using Your Benefits,” and then publications (Reporting On).
This site uses cookies. You must enable cookies so that you will only need to access this page and select your group once. The site will remember your group for future visits. You will have the option of changing your group at any time after the initial log on. www.cs.ny.gov/employee-benefits/nyship/shared/ publications/reporting-on/index.cfm
• Diabetes (August 2018) discusses
Empire Plan claims deadlines for calendar year 2018
Empire Plan enrollees have until April 30, 2019 (120 days after the end of the calendar year) in which to submit medical expenses which were incurred during the 2018 plan year to:
United HealthCare Service Corp. P.O. Box 1600
Kingston, N.Y. 12402-1600 empireplanproviders.com/ claimform.htm
For the Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and for non- network physical therapy or chiropractic services.
Empire Blue Cross and Blue Shield NYS Service Center
P.O. Box 1407 – Church Street Station New York, N.Y. 10008-1407
For Empire Plan and non-network Inpatient or outpatient hospital services.
Beacon Health Options
P.O. Box 1850
Hicksville, N.Y. 11802
For non-network mental health and substance abuse services.
CVS Caremark
P.O. Box 6590
Lee’s Summit, M.O. 64064-6590 For prescriptions filled at
non-participating pharmacies or at participating pharmacies without using your New York Government Employee Benefit Card.
Enrollees can call the Empire Plan at 1-877-7NYSHIP (1-877-769-7447) with questions or to obtain claim forms. As a reminder, when using the Empire Plan’s toll-free telephone number, please pay extra attention to the choices offered by the automated system.
Network providers/pharmacies will submit claims directly to the appropriate insurance carrier on your behalf when provided with all necessary information. If you have a
non-network claim submission, make sure you complete the requested subscriber information on the claim form, include the original billing
or receipt (if requested), and don’t forget to sign the claim form.
March 2019
The Work Force 17